Thursday, May 24, 2012

Medical Interpreting in European Hospitals

I have been studying cross border care in Europe for more than a year. This gave me the impression that it is easy to seek for health services within Europe. "If something happens to you, you can arrange a medical examination with the best doctor you can find, in any European county" is what I used to mention as an example of cross border care benefits.
Well, it is not so easy in the real world. I tried to find the best doctor for a specific type of cancer. It took me less than 2 minutes to find that he was based in France and some communication details. Should I call him for an arrangement and speak English?Can he speak English?He can obviously not speak Greek. If he speaks English will I understand everything correctly?If I send him an English speaking patient who will be operated and will stay in a French Hospital for 10 days, will he be able to communicate and be informed sufficiently?What if he can neither speak English, nor french?He probably needs a medical interpreter. When will the interpreter have to go to the hospital, and for how long?Will the hospital arrange this for you or not?
It is easy to understand things get complicated when you do not speak the language of the country you visit.
I was really curious about the solution of this problem. I attended a 2 weeks training programme for community interpreters and they played this video to show us how medical interpreting is...(Or maybe, how it should be)
How many of you have ever experienced or witnessed that? I have only witnessed Ad-hoc interpreting, mainly in the ER department, and I found it very helpful, but I consider it is a bit risky sometimes. Plus you do not always have an "Ad-hoc interpreter" available. Of course hospitals can not afford to have medical interpreters as we see on the video. But they can arrange to have one, when the doctor, or the patient believes it is critical to have someone to interpret. This is easy. What about an emergency? There you can use telephonic interpreting. The reason is that the health care professional or the patient may need interpreting "right now" either to explain, or to ask crucial questions. 
This is not always easy to ask, especially for the patient, because he can not easily explain that he needs to call an interpreter. Massachusetts hospitals have developed some patient identification methods such as the following:                     

(Source: Commonwealth of Massachusetts, Executive Office of Health and Human Services, Massachusetts Department of Public Health "BEST PRACTICE RECOMMENDATIONS FOR HOSPITAL-BASED INTERPRETER SERVICES" Office of Minority Health,Brunilda Torres, LICSW, Director)
Welcome cards, printed in many different languages, instructing patients to bring the card to the information desk if they need assistance; on the reverse side are instructions in English for how to contact interpreter services.

Wallet-sized cards with the patient’s primary language written in English, as well as instructions on how to reach an interpreter for that language.  Patients are able to provide this card at subsequent visits to specify their need for language assistance.

Staff badges in different languages with “I speak __ ! May I help you?” in the appropriate language; each badge is color-coded for low literacy patients. (For example, Spanish is always in purple, while Vietnamese is always in green.) Patients can then readily identify bilingual employees for assistance if they are lost or need directions.

Language identification charts can help literate LEP patients with requesting interpreter services.  One such chart is organized into a “patient-visitor” column which lists the question “Do you speak __ ?” in various languages, with a matching column indicating the name of the language in English.  Statistical demographic data can be used to determine which languages to include.
Theese are used to help identify the language the patient speaks, and make it easier for him to find the appropriate interpreter.
Most European hospitals are not even 10% ready to offer quality health services to foreign patient due to the  communicating language gap. There are dozens of organizations researching cross border care in Europe, hundrends of scientific articles, and almost nothing about medical interpreting, especially in NHS hospitals which are not so iternationaly oriented.

The last video is food for thought

Could you ever imagine this happening in your hospital? And how much time would it take to offer your services in this language. ASL interpreters are for Deaf people but telephonic interpreting can not be used for distance interpreting, unless you have a monitor on the phone, and there is a camera at the other side of the line.

Monday, March 5, 2012

Accrediting Hospitals in Europe

Ever questioned what accreditation is? And how important is it for you to find an accredited hospital if you are seeking hospital care abroad??? Is it same as certification? The rationale may be, similar but the level of detail in accredited systems is much higher.
Most people may have heard mostly about accredited laboratories, but accredited hospitals are totally different and hold a great competitive advantage if they seek for international patients. Of course it is a very expensive and long time effort, but in the same time, it is the most certain way to let foreign patients built trust on a hospital.

OK, let's leave patients and go to the other side. How to accredit a hospital?
Europe had two accreditation bodies. The first is in the United Kingdom with the "Trent Accreditation Scheme(now replaced by a number of independent accreditation schemes, such as the QHA Trent Accreditation) and the other is in France, known as "HAS (Haute Autorité de Santé)". The most common accreditation scheme and body is settled in the USA. Of course it is the Joint Commission International. Australia has "ACHSI", Canada has "Accreditation Canada" and New Zealand has Quality Health New Zealand (QHNZ). QHNZ quality standards where developed acording to the quality standards used by Australia and Canada.
Finally, India has National Accreditation Board for Hospitals & Healthcare Providers. 
Can the accreditation bodies be accredited? Sure they can. And who does this? An umbrella organisation,  ISQua (International Society for Quality in Healthcare) is the answer. The responsibility of this organisation is to accredit JCI accreditation scheme, QHNZ, Canadian Council on Health Services Accreditation, and the accreditation providers in United Kingdom and Australia.
Which scheme should I choose? Well, in my opinion this decision is 50% marketing and 50% organisational needs. If the Hospital is in Europe, and the the target group of patients is Europeans, you could try a European scheme. But if you seek for overseas patients maybe JCI accreditation scheme would probably work better.
So, a non-accedited hospital can't have international patients? Of course it can. Accreditation is only a big step to establish a position in the map of cross border healthcare. Another essential element is the reputation of your hospital and maybe of your country's NHS reputation. This is because potential "customers"-patients may build some kind of stereotypes about a country or a NHS. I don't get surprised to hear people saying "Ah, UK has the best hospitals" or "In France and Germany you can find the best doctors" or a country level comment " Finland and Sweden offer a very high level of services (generally) so I would not be afraid to visit a hospital there for my treatment". These people talk about these countries having no evidence, however their good reputation tends to help them gain trust and feel more secure there. Although this is only a perception, perception is extremely important in marketing.
In my opinion, a hospital with cross border prospects settled in Europe, should better be established in a reputable country, it should be accredited and (in my opinion again) it should offer competitive services, and not competitive prices. European hospital cost will never reach the hospital costs in Asia. So price competition will fail. Cross border care in Europe has a great potential if market researchers define which characteristics make the European hospitals be perceived as more secure and of higher quality. 

Friday, February 24, 2012

Health economic assessment tool (HEAT) for cycling and walking

That is a great tool WHO/Europe has developed. Try it yourself, a good way to estimate the financial benefits of walking and cycling. It also gives you the choise to perform cost-benefit analysis, in case you are thinking of investing money in the promotion of cycling/walking
Original post here
HEAT is an online resource to estimate the economic savings resulting from reductions in mortality as a consequence of regular cycling and/or walking. It is based on best available evidence, with parameters that can be adapted to fit specific situations. Default parameters are valid for the European context.
HEAT calculates the answer to the following question: if x people cycle or walk y distance on most days, what is the economic value of mortality rate improvements?
HEAT can be applied in many situations, for example:
  • to plan a new piece of cycling or walking infrastructure: it models the impact of different levels of cycling or walking, and attaches a value to the estimated level when the new infrastructure is in place (this can be compared to the costs to produce a benefit–cost ratio (and help make the case for investment), or as an input into a more comprehensive cost benefit analysis);
  • to value the mortality benefits from current levels of cycling or walking, such as benefits from cycling or walking to a specific workplace, across a city or in a country;
  • to provide input into more comprehensive cost–benefit analyses, or prospective health impact assessments: for instance, to estimate the mortality benefits from achieving national targets to increase cycling or walking, or to illustrate potential cost consequences of a decline in current levels of cycling or walking.
Examples of applications are available from several countries.
The development of HEAT was carried out within the Transport, Health and Environment Pan-European Programme (THE PEP) and in close collaboration with HEPA Europe. It was supported by an international advisory group of economists and experts on health, physical activity and transport.
We gratefully acknowledge the financial support received by Austria (Federal Ministry of Agriculture, Forestry, Environment and Water Management), Sweden (Swedish Expertise Fund), Switzerland (Swiss Federal Office of Public Health) and a consortium of donors from the United Kingdom under the leadership of Natural England and the European Union in the framework of the Health Programme 2008–2013 (Grant agreement 2009 52 02).

Thursday, January 12, 2012

Public Healthcare needs Sustainable Economies

Public expenses for healthcare in countries of the EU are usually measured as a rate of GDP. In order to have a sustainable economy, this rate has to be big enough for healthcare needs, but also small enough for other parts of the economy. So, the rationale is simple. When healthcare expenses rise, then this rate will also probably rise, so the growth rate of the economy (and GDP) has to be equal or bigger, in order to absorb this rise and maintain balance between parts of the economy.
In European Union trends have shown that healthcare expenses will rise even more in the future. According to the prediction of Economic Policy Committee 2001; Economic Policy Committee and European Commission 2006 the growth rates were also expected to be very high, so the expenses rise would be absorbed. And then the recession came. And unfortunately only half of the prediction came true. The expenses have raised significantly, but the growth rates didn’t. And this is how the fairytale of sustainability problems begins.

What we see in the above graph (taken from Eurostat) is the Real GDP growth rate through time. OK. Now let’s compare it with Healthcare expenses for the same time period in EU. The expenses in every single country go up.

What is needed to achieve economic sustainability??? How can we match the lines?? The GDP growth rate can not be influenced that easily. Unless you have a secret formula to stabilize euro. So, the expenditures have to follow the lines of real GDP growth. This means that public expenditure on healthcare should be cut to equivalent rates. This is not that simple. There are multiple factors that affect cost o healthcare. These factors will be discussed in the next post.

European governments don’t just face the problem of economic sustainability. Fiscal sustainability is something critical to worry about. What is fiscal sustainability in simple words? It is when a country has enough income to cover its expenses. Maybe fiscal sustainability is the greatest challenge of Member States. According to Willem H. Buiter, 2003 growth strategies will fail in the absence of fiscal sustainability. So, what member states do in order to cover their needs, is cutting expenses, raising taxes and borrowing for liquidity. The third creates a growing debt for them, and it makes it even harder to achieve fiscal sustainability in the future. IMF (2010) predicts that the rate of gross debt of general government to GDP will rise from 91% in the end of 2009, to 110% until 2015. It is quite simple to understand that all the above shrink the GDP of Member States. Less GDP means less for each part of the economy, including healthcare. The biggest question is if it also means lower level of health services quality. Maybe cross border care and medical mobility within Europe can increase competition, and lead to better prices and higher quality. Policy makers will show the way, and time will show whether sustainability is achievable or not. 

Friday, January 6, 2012

EUROPA - Press Releases - Health: driving forward the uptake of e-Health with a new network for European Co-operation

EUROPA - Press Releases - Health: driving forward the uptake of e-Health with a new network for European Co-operation:
The original post here

Brussels, 22 December 2011 – Today the European Commission adopted a Decision establishing an eHealth Network, as foreseen by the Directive (2011/24/EU) on Patients' Rights in Cross-border Healthcare. For the first time, EU legislation includes provisions on eHealth with clear objectives to find modern, innovative solutions for providing better and safer healthcare for all Europeans.

European Commissioner for Health and Consumer Policy, John Dalli said:"eHealth has the potential to deliver better healthcare to more people in a more sustainable manner. I am confident that the eHealth network will play a key role in making eHealth a reality across Europe: so that routine medical checks are performed in the comfort of our homes via telemonitoring; so that we take our ePrescription along with our eTicket when we travel, with the confidence that our medical information follows us everywhere in the EU; so that all Europeans can access the best possible healthcare wherever they are". To conclude : "I encourage all Member States to join the eHealth Network so that our joint efforts can reap benefits for all."

Neelie Kroes, European Commission Vice President for the Digital Agenda said The new eHealth Network promises to bring the health benefits of the digital economy to citizens across Europe. Interoperable eHealth can help improve the safety and efficiency of care of millions of Europeans who travel within the EU every year.

The Network's mission
The Network will bring together the national authorities responsible for eHealth on a voluntary basis to work on common orientations for eHealth. The aim is to ensure EU wide interoperability of electronic health systems and wider use of eHealth. The eHealth Network is expected to translate the results of numerous research projects and pilot projects into real-life accessible services for European citizens.

eHealth is healthcare practice supported by electronic processes and information communication technologies (ICTs) .
eHealth can play a central role in making health systems more efficient and effective by allowing for example remote diagnosis, remote monitoring of patients' conditions and secure sharing of patient records between healthcare professionals. The eHealth Network will play a key role in facilitating the future development of such services across Europe.
Council Conclusions in 2009 called for an alignment of eHealth with health strategies both at EU and at National level. In 2010 a Joint Action and Thematic Network were launched under the Health Programme and the Competitiveness and Innovation Programme.
To ensure coordination, coherence and consistency of work on eHealth at EU level and to avoid duplication of work, article 14 of the Cross-border Healthcare Directive (2011/24/EU) of 9 March 2011 sets up the voluntary eHealth Network adopted by today's Decision.
The eHealth network is mandated to draw up guidelines on a minimum set of common data to be included in patients' summaries; on methods to enable the use of medical information for public health and medical research; and on common identification and authentication measures to ensure transferability of data in cross-border healthcare.

Tuesday, January 3, 2012

Comparison of some Medical Tourism Organisations

Well, I am a patient and I am willing to travel abroad for a surgical operation. How do i find a hospital? I need some advise and information. Well google has all the answers... Theese are some of my findings and my description and comments on the purpose and role of each of the below organisations. All the information was obtained from their websites.  


Started in 2002-It is AA rated by Better Business Bureau since then.
Services: They arrange everything needed to travel in a country for medical reasons. This includes transport, hotel stay, hospital care and insurance. They also offer advise to help you choose the appropriate country and hospital to receive quality care in reasonable cost.
Insurance Offered:
  • CATA (Complication risk, Accidental death and Dismemberment, Travel Risk, Aftercare)
  • Diaspora (It is the insurance product that Planet Hospital launched. Not much relevance with Medical Tourism. It focuses on treatment in the US where health insurance is mandatory to receive complete medical care)
Partners Specifications: Planet Hospital does not certify its partners. As an assessment tool they use:
  • Online reviews for Surgeons and Healthcare Professionals
  • They actively review all partners in each country. Partners include hospitals, hotels, airlines etc.
Comments: Planet Hospital seems to mainly focus on reputational partners to gain trust, not all of them are accredited. However, in non-developed or non-reputational countries hospitals are JCI accredited. So there are not clearly stated specifications for hospitals to join the partners network. The network and procedures range seems to cover most cases, but it could be stated that there is a gap in quality assurance.
One of the partners is the Fertility Crete Centre (Greece)

General info: Based in Columbia-South Carolina
Member of: ISQua and SIIA*
*SIIA stands for Self Insurance Institute of America
Services: They arrange everything needed to travel in a country for medical reasons. This includes transport, hotel stay, hospital care and insurance. They also offer advise to help you choose the appropriate country and hospital to receive quality care in reasonable cost.
Insurance offered:
  • Medical Travel Insurance from independent Insurance company named “Global Protective Solutions”. Same cover as CATA
  • Insurance for medical care within the US
Partners Specifications: All Hospital facilities of the network are JCI Accredited.
“The American Medical Association (AMA) advises that companies recommending overseas health care only work with facilities that have been accredited by the Joint Commission International (JCI).”
Comments: The business offers a medium range of medical procedures, but with high quality specifications. Not much is mentioned about medical professionals, but quality is assured since all partner facilities are JCI accredited.
The website also offers an online tool to compare costs of procedures between hospitals worldwide.

Comparison of the procedures covered from Planet Hospital and Companion Global Healthcare
This table is used to indicate that there are different strategies among medical tourism organizations. Planet hospital covers more medical procedures, but the specifications for partnership with providers are lower than Companion Global’s. 

Procedures Comparison Table
Planet Hospital
Companion Global Healthcare


Post Bariatric

Ortho / Neuro

Hip Surgery
Knee Surgery

Cosmetic Dentistry
Basic Dentistry


Eye and Vision

Kidney / Liver / Pancreas

Liberation Treatment for MS

Radiation / Proton Beam


Cardio Testing

Heart Procedures
Lung Procedures



Radiation / Proton Beam

Surgical Oncology



Butt / Thigh Lift




Other Cosmetic

Post Bariatric

Sex Change

Total Makeover

Tummy Tuck

Medicine of Tomorrow

Knee Cartilage Replacement
Liberation Treatment for MS

Radiation / Proton Beam

Stem Cell Therapies


IVF & Surrogacy

Vasectomy / Tube Ligation Reversal

Not Listed-Other

0-10 Special Procedures

10-20 Special Procedures

Bupa started in the UK in 1947 with 38.000 customers.

Services: The business offers insurance products in multiple countries, Medical travel advice services, Healthcare services, and also does medical research.
The protection and risk business part of the organization (Bupa Health Assurance Ltd) is about to be sold to Resolution Ltd for £165,15million.

Comments: Bupa International has developed a quality assurance programme with the assistance of Joint Commission International (JCI).
The organisation offers only advice and insurance. There is a map with approved providers (including professionals, medical centres, hospitals) over the world, with contact info. Hygeia, Athens Medical Centre and Interbalkan European Medical Centre are partners.

The Blue Cross and Blue Shield Association (BCBSA) is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Organisation started 80 years ago and the headquarters are in Chicago.
Insurance offered: AskBlue Health Insurance
                                AskBlue Medicare
Services: Most services have to do with insurance. However there are some interesting advice tools used:
  • Blue Doctor or Hospitals finder. An application with body graphs and checklists that helps to find the appropriate provider (in National level)
·        Blue Distinction® is a designation awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare. The designation is based on rigorous, evidence-based, objective selection criteria established in collaboration with expert physicians' and medical organizations' recommendations. Its goal is to help consumers find quality specialty care on a consistent basis, while enabling and encouraging healthcare professionals to improve the overall quality and delivery of care nationwide.
Blue Distinction Example Criteria
Selection Criteria Category
Examples Include
Why This Matters to You
Patient Results (or Patient Outcomes)
Complication rates
Readmission rates
Mortality rate
Published averages for these measures often exist. Facilities are evaluated on how they compare to these averages to assess how well they do, overall, relative to their peers.
Physician credentials
Dedicated team focused on providing the particular area of specialty care
Length of time a facility has performed a procedure
Processes like advanced training programs for physicians in certain specialty areas and having patient care teams dedicated to one type of specialty care may lead to better overall care and outcomes for patients.
Number of times a particular procedure has been completed
Experience counts. Like the old adage, “Practice makes perfect,” research has shown that the more a facility performs a particular procedure, the better the overall outcomes for patients. It is worth noting, however, that this does not guarantee positive outcomes for individual patients.
Type of services provided (ER, diagnostic testing abilities)
Supporting departments (radiology, nutrition, social services, rehabilitation, etc.)
Use of clinical registry data systems
Expert input and guidance suggest that for various specialty care services, a distinguished level of care and management of patients requires the availability of key clinical services, such as diagnostic, medical and collaborative services.
Use of evidence-based care (e.g., use of beta blockers or aspirin for cardiac patients, which typically results in better outcomes)
Systematic follow-up of patient results after procedures
Quality improvement processes
Adherence to evidence-based (or clinically based) care processes, as well as a demonstrated focus on quality improvement, often relate to improved overall outcomes.
Comments: This organisation could be used as an example for advice that may be given to European citizens that wish to look for health related services within Europe.